527 Practical Use of Biomarkers During Nutritional Support of Pediatric Burn Patients

Abstract Introduction Current guidelines for evaluating nutritional risk in acutely ill patients incorporate the assessment of inflammation and disease burden. Inclusion of laboratory measures such as C-reactive protein (CRP) in screening criteria used to identify nutritional risk has gained credibility. Other biomarkers influenced by inflammation include visceral proteins albumin (ALB) and pre-albumin (PAB). While visceral proteins are not valid indicators of nutritional status, they may be indicators of nutritional risk, which could potentially lead to poor clinical outcome. The purpose of this study is to evaluate if PAB, ALB, CRP, are useful markers for predicting clinical outcomes in children with severe burn injury. Methods As part of our quality assurance program, we collect data on all nutrition support interventions, monitoring and outcome in children admitted to our hospital with significant burn injuries. This analysis describes data collected from 2006-2019 in children who had a burn injury and received nutritional support for five days or greater. Data elements collected include general demographics, weekly measures PAB, CRP, ALB; length of stay (LOS), number of intensive care unit (ICU) days, days to wound closure, and days on nutrition support. Biomarkers PAB, ALB, CRP and burn size (as an indicator of disease burden) were entered into a multiple regression model using a stepwise procedure for each dependent outcome variables (LOS, ICU LOS, Days to Wound Closure, and Days on Nutrition Support). Results A total of 182 patients, 7.0 ± 5.0 years of age with 41.1 ±16.9 % total body surface area (TBSA) burns were included in the analysis. TBSA, mean CRP and mean PAB were significant predictors of hospital LOS (R=0.60; p < 0.001); TBSA and PAB were significant predicters of ICU LOS (R=0.67; p< 0.000), days to wound healing (R= 0.37; p < 0.000) and days on nutrition support (R=0.60; p< 0.000). Albumin was not a significant predictor for any of the clinical outcome measures. Conclusions Our findings indicate that monitoring PAB and CRP is useful for identifying risk of poor outcome. Mean PAB was inversely associated with LOS, ICU LOS, days to wound healing, and days on nutritional support even when controlling for CRP and burn size.

Introduction: Burn patients with >20%TBSA suffer from a hypermetabolic state causing loss of muscle mass as well as a compromised immune system and delayed wound healing. Weight loss is most severe in patients with >20%TBSA with an initial gain of weight due to fluid resuscitation. These findings led the American Burn Association to propose new quality measures for burn-injury admissions, including weight loss from admission to discharge. We aim to assess how our institution's outcomes adhere to the proposed measures and if our findings correlate with previously described results. Methods: A retrospective review was conducted for adult patients admitted to our institution with burn injuries of >20%TBSA since 2016. Three groups were established based on %TBSA: 20-29% (Group 1), 30-39% (Group 2), and >40% (Group 3). We assessed weight changes from admission to discharge and performed a multivariate analysis to account for age, sex, number of surgical procedures, and hospital length-of-stay (LOS). Results: Data from 40 patients suffering burn injuries of >20%TBSA showed 11 patients with %TBSA of 20-29%, 10 patients with %TBSA of 30-39%, and 19 patients with %TBSA of >40%. When comparing groups 1 and 2, we saw significantly more weight loss in group 2 over the course of admission without a significant change in total hospital LOS. The average %weight loss for group 1 was 1.46%, 8.36% for group 2, and 10.56% for group 3. No patients in group 1 had a weight loss >15%. For group 2, patients with weight loss >15% had a significantly longer LOS and underwent significantly more surgical procedures during their admission. For group 3, most patients that experienced weight loss >20% did not have a longer LOS but did require more surgical procedures during their course of admission. Conclusions: Analysis of the data demonstrates that patients with >20%TBSA do suffer significant weight changes, likely due to extreme metabolic disturbances. Our data suggests that an increased length of stay is not a significant driver for weight loss changes between patients with %TBSA of 20-29 and 30-39, suggesting other pathophysiologic mechanisms in play. Our data supports the idea that patients with %TBSA>40 are a unique subset of patients, requiring specialized nutritional protocols and metabolic analysis.

527
Practical Use of Biomarkers During Nutritional Support of Pediatric Burn Patients

Jennifer Shiel, MS, RD, Kathy Prelack, PhD, RD Shriners Hospital for Children-Boston, Boston, Massachusetts; Shriners Hospitals for Children-Boston, Boston, Massachusetts
Introduction: Current guidelines for evaluating nutritional risk in acutely ill patients incorporate the assessment of inflammation and disease burden. Inclusion of laboratory measures such as C-reactive protein (CRP) in screening criteria used to identify nutritional risk has gained credibility. Other biomarkers influenced by inflammation include visceral proteins albumin (ALB) and pre-albumin (PAB). While visceral proteins are not valid indicators of nutritional status, they may be indicators of nutritional risk, which could potentially lead to poor clinical outcome. The purpose of this study is to evaluate if PAB, ALB, CRP, are useful markers for predicting clinical outcomes in children with severe burn injury.
Methods: As part of our quality assurance program, we collect data on all nutrition support interventions, monitoring and outcome in children admitted to our hospital with significant burn injuries. This analysis describes data collected from 2006-2019 in children who had a burn injury and received nutritional support for five days or greater. Data elements collected include general demographics, weekly measures PAB, CRP, ALB; length of stay (LOS), number of intensive care unit (ICU) days, days to wound closure, and days on nutrition support. Biomarkers PAB, ALB, CRP and burn size (as an indicator of disease burden) were entered into a multiple regression model using a stepwise procedure for each dependent outcome variables (LOS, ICU LOS, Days to Wound Closure, and Days on Nutrition Support). Results: A total of 182 patients, 7.0 ± 5.0 years of age with 41.1 ±16.9 % total body surface area (TBSA) burns were included in the analysis. TBSA, mean CRP and mean PAB were significant predictors of hospital LOS (R=0.60; p < 0.001); TBSA and PAB were significant predicters of ICU LOS (R=0.67; p< 0.000), days to wound healing (R= 0.37; p < 0.000) and days on nutrition support (R=0.60; p< 0.000). Albumin was not a significant predictor for any of the clinical outcome measures.

Conclusions:
Our findings indicate that monitoring PAB and CRP is useful for identifying risk of poor outcome. Mean PAB was inversely associated with LOS, ICU LOS, days to wound healing, and days on nutritional support even when controlling for CRP and burn size.